Lindsay Beyerstein tells us about a under-discussed threat to women’s health. Regulations on emergency contraception keep it out of the hands of people who have a legal right to it. A new study shows that the IUD is even better than you thought.

On this episode of Reality Cast, Lindsay Beyerstein will talk about a dramatically under-covered issue in women’s health care. Emergency contraception is legal over the counter, but restrictions keep people from getting what they are legally entitled to. And further evidence comes out that shows you probably should ovary up and get an IUD.

This made my week, so I thought I’d share it with you. It was a public service announcement the government put out in the 60s to inform women of their right to equal pay for equal work.

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Depressing, however, to think of how many ways employers still come up with to dodge the law, and the many bills trying to address that which aren’t getting passed.

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The New York Times recently put out an article explaining very carefully that emergency contraception simply isn’t abortion, but works under the same principle as condoms or the pill, by preventing pregnancy by keeping sperm from meeting egg. Emergency contraception works the same way as the birth control pill, by flooding the ovaries with hormones that suppress ovulation. The reason it works, though not as well as the pill, is because it takes sperm 3 to 5 days to get up into the Fallopian tubes to find an egg, giving you a window to prevent an egg from being there. Because emergency contraception is a one-time deal, it has none of the more dangerous side effects the pill can have, such as clotting, and thus doesn’t need a doctor’s supervision. In fact, it’s so safe that scientists believe that anyone who is over the age of puberty can use it without supervision, and the only reason that it’s behind the pharmacy counter at all is for political reasons. The Obama administration pandered to anti-choice forces last December and kept regulations in place that disallow those under 17 to buy the pill without a prescription. That means you have to ask for it, even if you’re over 17. And that means that ignorant or malicious pharmacy staff can still try to keep you from preventing pregnancy.

That’s what a New Jersey man—man!—recently learned when trying to buy emergency contraception for his girlfriend.

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Rite Aid violated both federal and state law when they denied him the right to buy E.C. Federal law states men can buy it, and state law forbids pharmacies from discriminating on the basis of gender. The ACLU of New Jersey demanded that Rite Aid apologize to this man and institute training so that employees know who can buy E.C. without a prescription, a group that yes, includes men. After all, many men are being gentlemen and buying for girlfriends, and it’s also important to realize that many transmen can get pregnant and also need access.

To their credit, Rite Aid responded with speed.

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One reason that pharmacies get confused is that there’s anti-choice propaganda out there suggesting that over the counter E.C. is being used by sexual predators to rape underage girls. While that may happen on occasion, it’s important to realize that sexual predators tend to be so domineering and aggressive that doing something like preventing an unintended pregnancy would ruin the fun for them. Most men buying E.C. have nothing but good intentions. While rapists aren’t really the ones out there trying to get E.C., however, rape victims actually are, and the hostility to emergency contraception and myths about it are preventing them from trying to prevent conception through rape.

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It becomes clear when you actually listen to people’s stories that this notion that anti-contraception people care about rape victims is an utter joke. Whenever rape victims talk about encountering anti-choicers in their journey, this is what it sounds like: They’re denied care, they’re treated like garbage, their experiences are questioned harshly by people who think they’re lying, and they face people who try to force them to get pregnant. The people who actually care about the victims are those who are trying to make sure they get care quickly as possible, and that includes care that involves emergency contraception. What all these stories show is that any kind of regulation that determines who can get emergency contraception does more than prevent minors from getting it. It keeps people who have a legal right to get it on demand without a prescription from getting it.

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Insert interview

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Oh boy, new IUD study! I don’t know how others feel about this, but I’m pretty geeky about the IUD and public health. There’s a ton of complaints out there that medical science isn’t coming up with new forms of contraception for women to choose from, but since the IUD was basically abandoned for decades, it’s like a new form of contraception. And for women who aren’t looking to get pregnant soon, it’s really starting to look like it’s the wonder contraception.

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That doesn’t mean that it’s time to panic if you’re on the pill. When they say that IUDs are 20 times better, that’s because IUDs fail so rarely that it creates a problem where anything looks exponentially worse by comparison. For instance, it’s exponentially more likely that I’ll break my leg today than a meteor will fall out of the sky and hit me, but both are unlikely to happen. But this also doesn’t mean that if you’re on the pill you should be complacent. What the researchers basically found is the big problem with the pill is women don’t take it right. Hormonal contraception, if used properly, is really effective and implants had roughly the same success rate as IUDs. But having to take a pill at the same time every day is really hard for many women, which is why we have such high failure rates for contraception in this country.

Researchers also found that there was a lot of variance in who the pill fails, presumably because different groups of women have different obstacles to taking it on a regular basis.

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Which makes perfect sense. It’s not just that young people tend to have less tightly scheduled lives, which makes it easier to remember to take your pill at the same time every day. It’s also that a lot of them may be in a situation where they may not have the privacy they desire to take the pill every day at the same time. The older you get, the more likely you are to have to leave your house at the same time every day, and the more likely you are to live with people who don’t care if you use contraception, and who don’t balk if you take your pill in front of them. These things matter.

Researchers also discovered complacency is a problem for pill users.

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You’d think the longer you do it, the better you’d get at taking it on time, but actually what happens is that all the times you take the pill blur together and you start to forget if you did or didn’t take it that day. It’s the same thing that causes people to wonder if they locked the door as they left the house. In addition, and I can say this from experience, there’s a tendency to become complacent if you skip a pill. The first time it happens, you panic, but then if it happens a couple of times and you don’t get pregnant, you stop worrying so much about it. But that’s how it can sneak up on you.

Currently, IUDs cost a lot of money, and that’s one of the major barriers, alongside education, to more women adopting them as their favored form of contraception. The pill costs more over the long run, but since it’s hard to come up with the thousand bucks or so to pay for an IUD right off the bat, a lot of women just won’t. But starting in 2013, under the Affordable Health Care Act, anyone who is insured will be able to get their contraception with no co-pay. That includes the IUD, both the device and the insertion. Hopefully we’ll see IUD rates go up then.

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And now for the Wisdom of Wingnuts, yeah, they really do think women are inferior edition. This is Bryan Fischer of the American Family Association making a well-worn right wing argument.

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You hear variations of the ‘hand that rocks the cradle rules the world” argument all the time. It’s intended to be flattering, but it’s an insult. The implication is that a woman simply could never be as impactful as a man in the larger world, so because she has limited abilities, she should stay at home. If you don’t buy the premise that no woman can compete with men in the public sphere, this argument makes no sense at all.